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Kansas rates for HCPCS C5276

Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,629.00 / $3,600.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,361.00 / $2,624.00 / $7,655.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.00 / $526.00 / $1,713.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.00 / $853.00 / $1,915.00